::::: Paramount Couriers :::::
Negative Declaration

I, _____________________________ (Name) declare that the articles listed below and covered by the invoice of entry to which this declaration relates are wholly the gross product or manufacture of a single foreign territory or country or insular possession of the U.S. of fabricated component which are in whole the product of U.S. as identified below. I declare that information set forth in this declaration is correct and true to the best of my information.

A _____________________________ (Country)

B _____________________________ (Country)

C _____________________________ (Country)

D _____________________________ (Country)

Marks of identification Numbers

Description of Article & Quantity

Country of Origin

Date of Exportation


Date :


__________________________________________

Name :

__________________________________________

Signature :

__________________________________________

Title :

__________________________________________

Company :

__________________________________________

Address :

__________________________________________
 

 

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